Wednesday, December 19, 2012

A recent article in The New York Times by Professor Richard A. Friedman, M.D., entitled, "In Gun Debate, A Misguided Focus on Mental Illness," is a bit of a hot item. I want to agree with Friedman. I support the fight for gun control. (If the Second Ammendment really means that all citizens have the right to privately own guns--and I don't think it does--then I think the Second Ammendment needs to be ammended.) But Friedman's piece is a terribly flawed, confused and misleading piece of work. Just from the point of view of argumentative integrity, it's bad.

Part of the problem is that I can't even be sure about Friedman's point of view. I want to be charitable, and suppose that his main point is something like this: Americans shouldn't let the discourse on mental illness distract us from the need for stricter gun control laws. If that is his main point, then I completely agree. Amen and all that.

I'll assume that was his motivating idea, but if so, then he lost his path somewhere between putting pen to paper and sending his article to press. The point he explicitly advocates is more like this: People who think we should try to keep guns out of the hands of the mentally ill are ignorant, lazy and unrealistic, and any attempt to focus on the role of mental illness in mass murder is a distraction. Then again, sometimes it's hard to tell just what he is arguing.

He sets up his argument here: "while no official diagnosis [of Adam Lanza] has been made public, armchair diagnosticians have been quick to assert that keeping guns from getting into the hands of people with mental illness would help solve the problem of gun homicides."

Notice, first, that he was talking about people's reactions to the mass shooting in Connecticut, and then he switches to a statement about gun homicides in general. Homicide is an extremely broad category. It's not even always illegal. Instead of taking on the argument about mass murder, Friedman sets up a straw man. It's relatively easy to downplay the role of mental illness in gun homicides in general. It's not so easy when you're talking about people like Adam Lanza.

Not only does Friedman set up a straw man, he also belittles his opponents by calling them "armchair diagnosticians." I guess anybody who thinks mental illness plays a significant role in mass shootings is too lazy to get up and do some research, or too ignorant of the evidence which is already readily available.

But there is evidence, and Friedman even suggests as much. He refers to "large-scale epidemiologic studies" which have shown that "a young psychotic male who is intoxicated with alcohol and has a history of involuntary commitment is at a high risk of violence." Indeed, alcohol and mental illness can be a very dangerous combination. Yet, even on this point, Friedman seems confused. He says that "most individuals who fit this profile are harmless." How is that? People with a certain profile are known to be high risk for violence, but most of them are harmless? If they're harmless, whence the high risk of violence?

I haven't even begun to dig into the confused, misleading dimensions of Friedman's article. He says, "there is overwhelming epidemiological evidence that the vast majority of people with psychiatric disorders do not commit violent acts.” That may be true, but it is irrelevant enough to be considered a non-sequitor. Now we're not even talking about homicides; we're talking about violence in general? We were talking about mass shootings, weren't we? In any case, let's assume that the vast majority of people with psychiatric disorders do not commit mass murder. I'm sure that's true, but it doesn't mean that certain mental illnesses or psychological profiles are not strong indicators of the potential for mass murder.

He also gives us an irrelevant statistic: "Only about 4 percent of violence in the United States can be attributed to people with mental illness.” If you follow the link that Friedman gives us there, you won't find support for that statistic. Instead, you'll find a study about people in Sweden. In any case, even if the statistic is true, it's irrelevant, because it is about violence in general, and not mass murder. Not even homicide.

By the way, there is some useful information in that link about Sweden. It says, "the risk of an individual with psychosis committing a violent offense compared with a general population group of a similar age is between two and six times for men and two and eight times for women.” So psychosis can increase the risk of violence considerably: up to six times as much for men and eight for women. Yet, Friedman makes it seem like psychosis only doubles the risk of violent behavior.

He says, speaking of mental illness in general, and not just psychosis, that "the risk is actually small." Furthermore, he never identifies which mental conditions are most strongly correlated with murder or even felonies in general. He doesn't mention personality disorders, some of which are strongly correlated with violence and felony convictions. Nor does he mention any of the neuroscientific evidence linking genetic, physiological and situational factors with murderous impulses. Instead, he mentions the relatively low risk of violence associated with schizophrenia and bipolar disorder. This only distracts us from the relevant empirical data.

It's worth looking at the NIMH study he uses to support his statement about schizophrenia and bipolar disorder. First of all, it relies on self-reported violent incidents. That severely limits what conclusions we can draw from the study. Despite those limitations, the study says: "In a multivariate model of the predictors of violence, a significant interaction effect was found between major mental illness and substance abuse. The risk of violent behavior increased with the number of psychiatric diagnoses for which respondents met DSM-III criteria.” Friedman's sources seem to be working against him.

Another irrelevant statement from Friedman: "Alcohol and drug abuse are far more likely to result in violent behavior than mental illness by itself." Yes . . . and? In case you didn't know, we should be even less inclined to give guns to the mentally ill when they're drunk. What argument is this supposed to be supporting again?

Friedman does make some relevant, even some cogent points. It is hard to predict a lot of violent behavior. It is hard to control the mentally ill's access to guns without making gun regulations generally stricter. Those are good points, and relevant. But Friedman also makes several additional problematic claims.

I think he's generally overly confident in his understanding of human behaviour. He says that "few" of the 120,000 gun-related homicides between 2001 and 2010 "were perpetrated by people with mental illness.” How does he know that? Because of the mysterious statistic that says only 4 percent of all violence in the US is associated with mental illness? So "violence" and "gun homicides" are interchangable? And anyway, I'm not so sure Friedman is correct that "people with mental illness contribute so little to overall violence." Personality disorders are over-represented in prison populations, for example.

Towards the end, Friedman admits that we might be able to help prevent mass murders by focusing on the early diagnosis of mental illness. So why all the attempts to make it seem like the people talking about mental illness were just full of hot air? Oh yeah, because he still thinks they are. He goes on to say, "All the focus on the small number of people with mental illness who are violent serves to make us feel safer by displacing and limiting the threat of violence to a small, well-defined group.”

That's not true. Mental illness can be terrifying. It is unpredictable, hard to control and poorly understood. Focusing on the role of mental illness in mass murder does not make me feel safer. It doesn't limit the threat of violence to a small, well-defined group. Quite the contrary. It rather opens the door to a discussion of just how prevalent mental illness might be, and what steps we can and should take to protect ourselves from it.

Friedman ends with these lines: "But the sad and frightening truth is that the vast majority of homicides are carried out by outwardly normal people in the grip of all too ordinary human aggression to whom we provide nearly unfettered access to deadly force.”

I don't think Friedman knows as much as he thinks about the hearts and minds of the vast majority of people who commit homicide. (Why homicide, by the way??) More importantly, I think Friedman is too willing to accept a very high level of human aggression in society. There is a great deal too much violence in America, and many other places. Friedman wants to normalize violence and ignore the possibility that mental illness is widespread and endemic in America today.

Mental illness is not a distraction from the real issues. It is part of the problem. So are too-lax gun laws. I hope the focus on both continues unfettered.

A recent article in The New York Times by Professor Richard A. Friedman, M.D., entitled, "In Gun Debate, A Misguided Focus on Mental Illness," is a bit of a hot item. I want to agree with Friedman. I support the fight for gun control. (If the Second Ammendment really means that all citizens have the right to privately own guns--and I don't think it does--then I think the Second Ammendment needs to be ammended.) But Friedman's piece is a terribly flawed, confused and misleading piece of work. Just from the point of view of argumentative integrity, it's bad.

Part of the problem is that I can't even be sure about Friedman's point of view. I want to be charitable, and suppose that his main point is something like this: Americans shouldn't let the discourse on mental illness distract us from the need for stricter gun control laws. If that is his main point, then I completely agree. Amen and all that.

I'll assume that was his motivating idea, but if so, then he lost his path somewhere between putting pen to paper and sending his article to press. The point he explicitly advocates is more like this: People who think we should try to keep guns out of the hands of the mentally ill are ignorant, lazy and unrealistic, and any attempt to focus on the role of mental illness in mass murder is a distraction. Then again, sometimes it's hard to tell just what he is arguing.

He sets up his argument here: "while no official diagnosis [of Adam Lanza] has been made public, armchair diagnosticians have been quick to assert that keeping guns from getting into the hands of people with mental illness would help solve the problem of gun homicides."

Notice, first, that he was talking about people's reactions to the mass shooting in Connecticut, and then he switches to a statement about gun homicides in general. Homicide is an extremely broad category. It's not even always illegal. Instead of taking on the argument about mass murder, Friedman sets up a straw man. It's relatively easy to downplay the role of mental illness in gun homicides in general. It's not so easy when you're talking about people like Adam Lanza.

Not only does Friedman set up a straw man, he also belittles his opponents by calling them "armchair diagnosticians." I guess anybody who thinks mental illness plays a significant role in mass shootings is too lazy to get up and do some research, or too ignorant of the evidence which is already readily available.

But there is evidence, and Friedman even suggests as much. He refers to "large-scale epidemiologic studies" which have shown that "a young psychotic male who is intoxicated with alcohol and has a history of involuntary commitment is at a high risk of violence." Indeed, alcohol and mental illness can be a very dangerous combination. Yet, even on this point, Friedman seems confused. He says that "most individuals who fit this profile are harmless." How is that? People with a certain profile are known to be high risk for violence, but most of them are harmless? If they're harmless, whence the high risk of violence?

I haven't even begun to dig into the confused, misleading dimensions of Friedman's article. He says, "there is overwhelming epidemiological evidence that the vast majority of people with psychiatric disorders do not commit violent acts.” That may be true, but it is irrelevant enough to be considered a non-sequitor. Now we're not even talking about homicides; we're talking about violence in general? We were talking about mass shootings, weren't we? In any case, let's assume that the vast majority of people with psychiatric disorders do not commit mass murder. I'm sure that's true, but it doesn't mean that certain mental illnesses or psychological profiles are not strong indicators of the potential for mass murder.

He also gives us an irrelevant statistic: "Only about 4 percent of violence in the United States can be attributed to people with mental illness.” If you follow the link that Friedman gives us there, you won't find support for that statistic. Instead, you'll find a study about people in Sweden. In any case, even if the statistic is true, it's irrelevant, because it is about violence in general, and not mass murder. Not even homicide.

By the way, there is some useful information in that link about Sweden. It says, "the risk of an individual with psychosis committing a violent offense compared with a general population group of a similar age is between two and six times for men and two and eight times for women.” So psychosis can increase the risk of violence considerably: up to six times as much for men and eight for women. Yet, Friedman makes it seem like psychosis only doubles the risk of violent behavior.

He says, speaking of mental illness in general, and not just psychosis, that "the risk is actually small." Furthermore, he never identifies which mental conditions are most strongly correlated with murder or even felonies in general. He doesn't mention personality disorders, some of which are strongly correlated with violence and felony convictions. Nor does he mention any of the neuroscientific evidence linking genetic, physiological and situational factors with murderous impulses. Instead, he mentions the relatively low risk of violence associated with schizophrenia and bipolar disorder. This only distracts us from the relevant empirical data.

It's worth looking at the NIMH study he uses to support his statement about schizophrenia and bipolar disorder. First of all, it relies on self-reported violent incidents. That severely limits what conclusions we can draw from the study. Despite those limitations, the study says: "In a multivariate model of the predictors of violence, a significant interaction effect was found between major mental illness and substance abuse. The risk of violent behavior increased with the number of psychiatric diagnoses for which respondents met DSM-III criteria.” Friedman's sources seem to be working against him.

Another irrelevant statement from Friedman: "Alcohol and drug abuse are far more likely to result in violent behavior than mental illness by itself." Yes . . . and? In case you didn't know, we should be even less inclined to give guns to the mentally ill when they're drunk. What argument is this supposed to be supporting again?

Friedman does make some relevant, even some cogent points. It is hard to predict a lot of violent behavior. It is hard to control the mentally ill's access to guns without making gun regulations generally stricter. Those are good points, and relevant. But Friedman also makes several additional problematic claims.

I think he's generally overly confident in his understanding of human behaviour. He says that "few" of the 120,000 gun-related homicides between 2001 and 2010 "were perpetrated by people with mental illness.” How does he know that? Because of the mysterious statistic that says only 4 percent of all violence in the US is associated with mental illness? So "violence" and "gun homicides" are interchangable? And anyway, I'm not so sure Friedman is correct that "people with mental illness contribute so little to overall violence." Personality disorders are over-represented in prison populations, for example.

Towards the end, Friedman admits that we might be able to help prevent mass murders by focusing on the early diagnosis of mental illness. So why all the attempts to make it seem like the people talking about mental illness were just full of hot air? Oh yeah, because he still thinks they are. He goes on to say, "All the focus on the small number of people with mental illness who are violent serves to make us feel safer by displacing and limiting the threat of violence to a small, well-defined group.”

That's not true. Mental illness can be terrifying. It is unpredictable, hard to control and poorly understood. Focusing on the role of mental illness in mass murder does not make me feel safer. It doesn't limit the threat of violence to a small, well-defined group. Quite the contrary. It rather opens the door to a discussion of just how prevalent mental illness might be, and what steps we can and should take to protect ourselves from it.

Friedman ends with these lines: "But the sad and frightening truth is that the vast majority of homicides are carried out by outwardly normal people in the grip of all too ordinary human aggression to whom we provide nearly unfettered access to deadly force.”

I don't think Friedman knows as much as he thinks about the hearts and minds of the vast majority of people who commit homicide. (Why homicide, by the way??) More importantly, I think Friedman is too willing to accept a very high level of human aggression in society. There is a great deal too much violence in America, and many other places. Friedman wants to normalize violence and ignore the possibility that mental illness is widespread and endemic in America today.

Mental illness is not a distraction from the real issues. It is part of the problem. So are too-lax gun laws. I hope the focus on both continues unfettered.